ECMO for Providers

ECMO for providers

Referring a patient to ECMO

Infants, children, teens and adults suffering from severe cardio-pulmonary failure and other life-threatening conditions may require the use of extracorporeal membrane oxygenation (ECMO). ECMO is a sophisticated procedure, similar to the heart-lung bypass machine used in cardiac surgery, which takes over the oxygenation and heart function in patients with serious lung disease, cardiac disease, or trauma.

We accept questions and referrals 24 hours a day, seven days a week. We are happy to receive consultations or to arrange transfer from centers in Oregon, Washington and the surrounding regions.

A standard of care with solid results

At the Legacy Emanuel Medical Center we utilize ECMO when indicated as a routine aspect of our protocolized approach to ARDS when other means of oxygenation and/or ventilation are insufficient or less safe.

ECMO has become increasingly safe and efficient and is emerging as a standard of care for patients with refractory hypoxemic ARDS. Outcomes are significantly improved with both adult ARDS and H1N1 pneumonia if patients are cared for in an ECMO center. We also use ECMO to support circulation as appropriate for profound shock (septic and cardiogenic), hypothermia or in the extremes of resuscitation.

In the years 2013-2014 our survival-to-discharge rate for adults with respiratory failure has been greater than 81 percent. These patients were profoundly hypoxic, with an average PF ratio of 55 on maximal ventilator support. The international norm for a similar cohort of patients is 59 percent. For patients with H1N1 pneumonia, our current survival to discharge rate is 77 percent. Both of these rates of success reflect our experience and program evolution as a regional referral center.

For more, see ECMO: our history, references. To learn more about our experience and results in treating H1N1 patients, go here.

The survival rate for children treated with ECMO at Randall Children’s Hospital has been 75 percent and the VDR ventilator is used to prevent young patients from requiring ECMO and to assist with their recovery on ECMO.

Transport capabilities

To speed your patients' safe access to potentially lifesaving therapy, we provide the only dedicated and immediately available ECMO transport team in the Pacific Northwest for adults and adolescents. This mobile critical-care team consists of two attending surgeons, a perfusionist, a respiratory therapist, an OR nurse and a trauma resuscitation/ICU nurse.

More than 90 percent of our ECMO patients are referred from outside Legacy Emanuel, and almost 70 percent of them have required that ECMO be initiated at the referral center to ensure safe transport, underscoring our team's depth of experience.

From 2009–2013 we transported 62 adult patients, all on ECMO.

Among the places from which we transported patients: Albany, Newberg, Roseburg, Corvallis and Bend in Oregon; Tacoma and Federal Way, Washington; and Anchorage, Alaska

Recognized for excellence

Legacy Emanuel Medical Center and Randall Children’s Hospital at Legacy Emanuel, a regional leader in ECMO for decades, has a focused program for each age group, from newborn to children and teens to adults. We have the most experience using the therapy of any medical center in the regions and the capability to treat and care for six patients on ECMO simultaneously.

Legacy's ECMO program has earned the ELSO (Extracorporeal Life Support Organization) Award for Excellence in Life Support. This award signifies that our program has been recognized as a “distinguished leader in critical care" and provides high-quality, state-of-the-art care. The ELSO Award of Excellence is recognized by US News and World Report and Parents magazines as a criterion for top institutions.

According to ELSO, our program "demonstrated extraordinary achievement" in patient care, training, collaboration, education and communication. A designated Center of Excellence has demonstrated extraordinary achievement in:

Promoting the mission, activities, and vision of ELSO

Patient care by using the highest quality measures, processes, and structures based upon evidence

Training, education, collaboration and communication supporting ELSO guidelines that contributes to a healing environment for families, patients and staff.

The ELSO Award signifies to patients and families a commitment to exceptional patient care. It also demonstrates to the health care community an assurance of high quality standards, specialized equipment and supplies, defined patient protocols, and advanced education of all staff members.

Information for patients

Patients can read about our ECMO services here; for pediatric ECMO, patients and families can find more information is here.

Expert consultation

If you are treating an infant, child or adult suffering from severe cardio-respiratory failure who is not responding to standard medical treatment, the experts at Legacy Emanuel and Randall Children’s Hospital provide collaborative, consultative advice. Our experience with hundreds of ECMO cases shows that early dialogue is crucial to optimal patient survival and outcomes. Survival of the potential ECMO patient is correlated to appropriate and safe transfer of the patient before the patient actually meets the clinical criteria for ECMO therapy –– we encourage you to call.

More patients with severe lung failure (ARDS) survive ECMO if it is started before they have been on the ventilator (breathing machine) for more than a few days. It is important to call us early. We are dedicated to be available to help these profoundly ill patients, their families and our community by providing this care at the highest possible standards.

In addition to ECMO, we offer a full spectrum of related therapies. These include advanced ventilator management, kidney support therapy, plasmaphoresis, sophisticated monitoring, imaging and cardiac assist devices. All of these services are under the direction of specially trained, experienced and board-certified neonatal, pediatric and medical and surgical care specialists.

Rooms in Randall Children's Hospital in the NICU and PICU are large enough to have room for the ECMO equipment.

For adults, a new critical care unit has been designed for state-of-the art care in a family-oriented setting. Family and friends are welcome to participate while at the bedside of their loved one.

Specialized, dedicated team –– around the clock

Our program features a range of specialists to provide minute-to-minute bedside support for the complex technology.
• ECMO-trained neonatologists and pediatric intensivists are available around the clock in the Neonatal Intensive Care Unit (NICU) and in the Pediatric Intensive Care Unit (PICU).
• Specially trained ECMO physicians work with pediatric surgeons, cardio-thoracic surgeons, trauma surgeons, cardiologists, and renal and pulmonary specialists to care for ECMO patients.
• The ECMO nurse specialist operates the ECMO machine, making adjustments. An additional nurse monitors vital signs and other aspects of patient care.
• We have a full team of specialists, perfusionists, therapists and more

ELSO database registry

ELSO maintains an international registry of information about ECMO patients. We submit information on each ECMO patient to this database, which provides us with invaluable information about ECMO therapy, underlying illnesses and patient outcomes. We use this data to evaluate and continually improve our care of the ECMO patient.